儿童副脾扭转3例并文献复习

Accessory spleen torsion in children:a report of 3 cases and literature review

目的探讨儿童副脾扭转的临床特征及治疗手段。方法收集2019年12月至2021年11月南京医科大学附属儿童医院收治的3例副脾扭转患儿临床资料,其中男1例,女2例;年龄范围为11岁5个月至13岁7个月,2例患儿通过术中及术后病理证实,1例患儿通过B型超声及CT检查明确。通过PubMed数据库、万方医学网及申请文献传递等方式收集1962年9月至2021年10月以中文、英文发表的涉及儿童副脾扭转的相关文献,分析副脾扭转患儿的临床症状、影像学特征及治疗方法。结果病例1、2行腹腔镜副脾切除术后恢复良好,病例3行保守治疗,梗死副脾明显缩小,目前仍在随访中。共检索到儿童副脾扭转梗死相关文献24篇共计24例。其中男女占比50%,发病年龄为(8.87±5.19)岁,以腹痛为主要症状的比例达到87.5%(21/24),梗死副脾长轴为(6.13±2.27)cm。副脾所在部位以大网膜(37.5%,9/24)及脾门(16.7%,4/24)为主,绝大部分患儿都是通过B型超声及CT来协助诊断,术前只有22.7%(5/22)的病例能够明确诊断。副脾梗死的治疗方式包括开腹手术、腹腔镜手术及保守治疗。结论儿童副脾扭转非常罕见,误诊率高,临床主要通过B型超声及CT检查辅助诊断,目前治疗方法以腹腔镜手术为主。

Objective To explore the clinical characteristics and treatments of accessory spleen torsion(AST)in children.Methods Clinical data were retrospectively reviewed for 3 AST children aged(137-163)month(one boy,two girls)from December 2019 to November 2021.Two cases were confirmed by intraoperative findings and postoperative pathology while another case was directly diagnosed by ultrasonography and computed tomography(CT).Literatures related to AST were retrieved from PubMed,WanFang and application document delivery from September 1962 to October 2021.Results Two cases of laparoscopic accessory splenectomy had a decent prognosis.In another child,volume of infarcted accessory spleen declined markedly after conservative measures.A total of 24 articles involving 24 cases related to AST in children were retrieved.The average onset age was(8.87±5.19)years,the proportion of patients with abdominal pain as a major symptom reached 87.5%(21/24)and average long axis of infarcted accessory spleen was(6.13±2.27)cm.Infarcted accessory spleens were located predominantly at greater omentum(9/24)and splenic hilum(4/24).Most cases were diagnosed by type B ultrasound and CT and only 22.7%(5/22)cases could be diagnosed correctly pre-operation.The treatments for infarcted accessory spleen included conservative measures,laparotomy and laparoscopy.Conclusions AST is clinically rare in children and its diagnosis is made by ultrasonography and CT with a high misdiagnostic rate.Currently laparoscopy remains a major treatment.